The present study aimed to compare the long-term clinical and functional outcomes of patients with clinically localized prostate cancer treated with radical prostatectomy compared to the watchful waiting.

Methods

PubMed، Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies were scrutinized from inception to Jan 2018. Two reviewers conducted data abstraction and quality assessment of included trials independently. Quality of included studies were assessed by using Cochrane checklist. Inverse-variance and Mantel-Haenszel estimates under random effects model were used to pool results as relative risks with 95% confidence interval. Heterogeneity was assessed by using I2.

Results

Three randomized controlled trials with 1568 participants were included. Compared to watchful waiting، radical prostatectomy had no significant effect on all-cause mortality at 12-year follow-up. However، radical prostatectomy had significant effect on reducing prostate-cause mortality at 12-year follow-up. We found significant lower prostate-cause mortality in patients with PSA>10 and GS≥7 scores who had undergone radical prostatectomy compared with patients in watchful waiting group. In addition، younger patients undergoing surgery developed lower distant metastases rate compared to another approach. Watchful waiting had a significant effect on erectile and urinary incontinence during 2 years.

Conclusion

There was no significant difference between radical prostatectomy and watchful waiting on all-cause mortality. However، the radical prostatectomy was associated with statistically lower prostate-cause mortality and metastases rates. Compared with older men، younger men experienced better clinical outcomes. Moreover، watchful waiting had better effect on reducing erectile dysfunction and urinary incontinence among patients during 2 years compared to radical prostatectomy.

In the current study، we aimed to explain the concept of stewardship by employing a critical review perspective and، finally، to develop a model.

Methods

Critical review method and Carnwell and Daly approach and using particular keywords related to stewardship، and searching databases were used. In the initial search، until 2018، 1050 studies were obtained، which using targeted sampling method، 32 studies were finally selected. Then، selected studies were criticized and finally، and the conceptual model of stewardship was designed and explained.

Results

After reviewing and criticizing; the concept and aspects of the model were categorized in the sub-tasks of knowledge-generation، strategic framework، evidence-based policy-making، system design، resource allocation، capacity building، enforcement/alignment، that through operation leads to achieving goals. Final model was categorized into three effective levels.

Conclusion

Some studies mentioned the governance and stewardship as same concepts، while our results showed that policy-making، governance and leadership، and many other concepts، can be categorized as a part of stewardship.

In this narrative-review، the articles and official reports on HRTLS، were gathered and analyzed from related textbooks and indexing sites with the defined keywords in English or Persian. The search of databases such as IDTechEx، IEEE، PubMed Central، Science Direct، EMBASE/Excerpta Medica، Scopus، Web of Science، Elsevier journals، WHO publications and Google Scholar was performed to reconfirm the efficiency of HRTLS from 2006 to 2017.

Results

Various technologies have been used in the current systems، which have led to the reduced error rate، costs and increased speed of providing the healthcare services. Applications of these systems include tracking of patient’s، medical staff and valuable medical assets. Besides، achieving the patient & staff satisfaction is among other basic applications of these Systems. The accurate data exchange and processes control are considered as positive aspects of this technology.

Conclusion

HRTLS has great importance in healthcare systems and its efficiency in medical centers is reliable; hence، it seems necessary to determine the organization’s requirements، apply novel technologies such as cloud computing and Internet of things، and integrate them to get access to maximum advantages in Iranian healthcare centers.

Cefepime-resistant Escherichia coli (E. coli) is one of the seven important types of microbial resistance. This meta-analysis study was conducted to identify the prevalence of cefepime-resistant E. coli in Iran during 2007-2016.

Methods

Studies published were searched in Persian databases (including Magiran، and SID) and international databases (including PubMed، ScienceDirect، and Scopus). The selected studies included all types of laboratory methods. Moreover، the random effects model (DerSimonian Laird method) was used to addresses the high heterogeneity (50% < I2) between the reviewed studies. The collected data were categorized into different subgroups on the basis of the year of study and province. Data analysis was performed using the Statsdirect software.

Results

Overall، 516 articles were selected from the searched medical databases. After reviewing and applying the inclusion criteria، irrelevant papers were excluded and the remaining 26 studies were meta-analyzed. The overall prevalence of cefepime-resistant E. coli was 53.42% (95%: 43.35، 63.35)، ranging from 25% (95%CI: 21.67، 28.55) in 2009 to 61.95% (95%CI: 56.62، 67.09) in 2016.

Conclusion

The prevalence of cefepime-resistant E. coli in Iran has had an increasing and alarming trend during the recent years. Therefore، it is necessary to use practical strategies and interventions to control and monitor cefepime-resistant E. coli in the country.

The Effect of Mother-Infant Skin to Skin Contact after Birth on Third Stage of Labor: A Systematic Review and Meta-AnalysisFatemeh Zahra KARIMI,Hamid HEIDARIAN MIRI,Maryam SALEHIAN,Talat KHADIVZADEH,Mohaddese BAKHSHI *Pages 612-620Abstract Full Text [PDF 1124KB]

Background

One of the causes of postpartum hemorrhage is prolongation of third stage of labor. Mother-infant skin to skin contact (SSC) immediately after delivery is one of the non-pharmacological interventions to reduce this stage. Studies which assessed the effect of mother-infant SSC after delivery on duration of the third stage of labor reported controversial results on this issue. Therefore، this study investigated the effect of mother-infant SSC immediately after birth on the duration of third stage of labor

Methods

In this systematic review and meta-analysis، the databases of PubMed، Scopus، Cochrane، SID، Magiran IranDoc and Google Scholar were searched from 2000 to 2018، using the keywords related to the objectives of this review to access randomized control trials published in Persian or English. The quality of papers was examined using Cochran's Risk of bias tool. Data was analyzed using Stata software. We used I2 index and Chi-square test to investigate heterogeneity and Egger’s and Begg’s tests to assess publications bias. Random effects model was used to combine the data.

Results

Six studies were entered into the meta-analysis. The third stage of labor in SSC group was shorter than that of control group with a mean difference of -1.33 and 95% CI (-2.31 to -0.36) and this difference was statistically significant (P=0.007).

Conclusion

Mother-infant SSC decreases the duration of third stage of labor. Therefore، the current study provides some evidences to use this non-pharmacological method in order to accelerate the third stage of labor and ultimately prevent postpartum hemorrhage.

Studies related to the prevention and control of myopia in adolescents have increased rapidly، but only a few have measured the levels of scientific collaboration among authors، institutions and countries in this field. Thus، in this study، we aimed to reveal the status and levels of scientific collaboration in this field.

Methods

The research population included all published papers in the field of adolescent myopia prevention and control indexed in the Web of Science databases from 1997-2016. The co-authorship networks were drawn using SATI (Statistical Analysis Toolkit for Informetrics)، Ucinet and VOS viewer (Visualisation of Similarities viewer). Active authors and some measures of co-author network، including degree centrality، closeness، betweenness، density and diameter، were also assessed.

Results

Overall، 610 records were obtained، and a number of publications developed through an increase in different collaboration types، with cooperation among authors and institutions as the most apparent ones. The top ten active authors and institutions were identi?ed. The density of cooperative networks of the top 70 authors and the first 69 institutions were 0.043 and 0.011، respectively، with corresponding diameters of five and six، respectively. Seven distinct clusters formed the cooperation network among 38 countries. The top three clusters were centered in China، the United States and Australia، also identified as the most productive countries.

Conclusion

The flow of information is slow and the collaboration among authors and institutions in the network are not close enough. Thus، multiple collaboration types should be encouraged in this field، especially among countries.

Trace elements play a pivotal role in Colorectal Cancer (CRC) inhibition and development process. This systematic review provides the basic comparison of case-control studies focusing on concentration of trace elements between those with CRC and controls

Methods

The systematic review searched through two databases of Medline and Cochrane up to 24th June 2017. The search strategy focused on Population، Intervention، Comparison، and Outcomes (PICO). We searched the role of trace elements in cancer and focusing on case-control studies in CRC to obtain an insight into the differences in trace element concentrations between those with and without cancer.

Results

The serum concentrations of Ca، Cu، Mg، Mn، Se، Si، and Zn were lower in CRC patients but for Co and S the levels were higher in CRC patients. The concentrations of Cd، Cr، Cu، Mg، Mn، Pb، and Zn were increased in patients with metastasis، but not in Se. As for colon tissue specimens، inconsistent levels were reported between studies، notably in Cu، Se، and Zn. No changes were reported for B and Ca levels. Most of the trace elements in the tissue specimens showed higher concentrations of Cr، Fe، K، Mg، P، Rb، S، and Si compared to Br.

Conclusion

With the growing interest to understand the link between trace elements in carcinogenesis and the possible interactions، multi assessment analysis of a larger cohort of samples is necessary.

Vitamin D is an essential substance for absorption of calcium and phosphorus from intestine so it is vital for muscles and skeletal development. Deficiency of this vitamin is pandemic. The vitamin D status depends on the different factors such as UV exposure، diet، and ecological features of living location، age and gender. The aim of this study was to describe the vitamin D level in different provinces of Iran and to investigate the association between vitamin D status and multiple variables.

Methods

We collected the serum 25(OH)D (Vitamin D) level data of 308،005 people referred to different laboratories from 30 provinces of Iran and organized them by each province، year، age، gender، precipitation، latitude and longitude، and humidity over 10 yr (2009-2018). Data were analyzed to find out the correlation between age، gender، longitude and latitude، humidity and sum of precipitation.

Results

West Azerbaijan had the highest level of vitamin D with a mean level of 33.24 and a standard deviation of 32.001، and North Khorasan had the lowest level with a mean level of 14.46 and a standard deviation of 8.980 among 30 provinces of Iran. The correlation between all studied variables (age، and gender، latitude and longitude، humidity، the sum of precipitation) was significant (P<0.001).

Conclusion

The average total vitamin D level in Iran is 25.41 ng/ml، which is within the area of deficiency. Vitamin D is associated with age، and gender، latitude and longitude، humidity، the sum of precipitation. So changes in any of these variables can lead to vitamin D alteration.

Keywords: Vitamin D deficiency, Epidemiology, Ira

Effects of Customized Long-Message Service and Phone-Based Health-Coaching on Elderly People with HypertensionMyoungsuk KIM*Pages 655-663Abstract Full Text [PDF 716KB]

Background

We aimed to develop long-message services (LMS) and phone-based health-coaching for community-dwelling seniors diagnosed with hypertension and assess the effects of the programs implemented both separately and together. These programs are easily applicable to seniors diagnosed with hypertension and will help control their blood pressure (BP) in a practical manner.

Methods

We conducted a single-blinded، randomized، controlled pragmatic trial. Individuals aged 65 years or older with hypertension at two senior welfare centers in Seoul، South Korea، who were able to take phone calls and check text messages were enrolled. The study included 124 participants: 31 in the control group، 30 in the health-coaching group، 32 in the LMS group، and 31 in the health-coaching-with-LMS group.

Results

Phone-based health-coaching with LMS was effective in improving medication adherence، hypertension self-efficacy، and self-management behavior and decreasing systolic BP as compared to LMS only. There were also improvements in medication adherence، hypertension-related knowledge، hypertension self-efficacy، self-management behavior، and systolic BP in the LMS group as compared to the control group.

Conclusion

Using phone-based health-coaching with LMS was effective for managing hypertension in community-dwelling seniors diagnosed with hypertension and could become a useful intervention method.

This study aimed to identify the characteristics of item nonresponse and examine the factors affecting the refusal or failure to respond of patients with chronic disease in rural China.

Methods

A cross-sectional survey data from patients with chronic disease from rural China were analyzed. A total of 1،099 patients were enrolled. Chi-square test and cumulative logistic regression determined the predictors of having item nonresponse.

This study indicates the influencing factors of the item nonresponse in survey of patients with chronic disease in rural China. This study contributes to investigation practice and highlights that health institutions should improve the quality of follow-up services. Moreover، the government should pay more attention to the care of vulnerable groups، especially patients with chronic disease in rural areas.

The gerontoism، a neologism adopted here، is a form of discrimination regarding age and can occur in rational، emotional، and behavioral contexts، and could be influenced by many factors. This study aimed to identify if the social support and the family functionality interfere in the self-perception of gerontoism.

Methods

Participants were 376 elderly in good physical and mental condition. They participated in the Group Living organization in the Municipality of Curitiba، State of Paraná، Brazil، in 2012. Information was collected about sociodemographic profile using a structured questionnaire. The social support، the family functionality، and the self-perception of gerontoism were defined by the Medical Outcomes Study، the Family APGAR index، and Ageism Survey، respectively. The variables were analyzed by Pearson’s correlation coefficient، One Way ANOVA، Tukey’s HSD test، and the Student’s t-test.

Results

Most of the participants came from small cities from the interior (48.7%)، were female (94.4%)، with age ranging 60-69 yr-old (45.5%)، whites (76.1%)، widowers (47.1%)، with children (93.9%)، with low schooling (55.3%)، with family income from 1-2 minimum wage (31.4%)، and retirees not working (44.1%). It was not observed correlation between sociodemographic variables and self-perception of gerontoism. Statistical significance was observed between self-perception of gerontoism and social support (r= -0.26، P=0.00)، and between the self-perception and family functionality (r = -0.28، P=0.00). Once the scores of self-perception of gerontoism increased، the ones from social support and family functionality، decreased.

Conclusion

Lower self-perception of gerontoism was observed in elderly with higher social support and family functionality.

To investigate the clinical significance of monitoring the coagulation indexes، immune factors and inflammatory factors in pregnancy-induced hypertension syndrome (PIH).

Methods

90 pregnant women with PIH admitted in Weihaiwei People's Hospital of Shandong Province، China from 2016 to 2017 were collected، including 45 cases in mild-moderate group and 45 cases in severe group. Another 45 normal pregnant women at the same period were selected as control group. The immune indexes، four index signs of coagulation bloods and serum inflammatory factors in three groups of subjects were determined.

Results

The levels of complement 3 (C3)، complement 4 (C4)، immunoglobulin A (IgA)، immunoglobulin G (IgG) and immunoglobulin M (IgM) were successively increased in severe PIH group، mild-moderate PIH group and normal pregnancy group (P<0.05). Compared with those in normal pregnancy group، the levels of PT، APTT and TT were significantly decreased and Fib levels were significantly increased in PIH groups (P<0.05). Compared with those in normal pregnant women، the levels of TNF-α and IL-6 in pregnant women with PIH were significantly increased (P<0.05)، and the changes in severe PIH group were more obvious than those in mild-moderate group.

Conclusion

Pregnant women with PIH are in a hypercoagulable state and have a higher risk of thrombus and secondary hyperfibrinolysis. Immune factors and inflammatory factors are also associated with the occurrence and development of the disease. Monitoring the changes in coagulation indexes and levels of immune factors and inflammatory factors provide an important reference value for clinical treatment and prevention of complications.

Vector control is still emphasized on the using of chemical insecticide which can cause death of non-target organisms، pollution and vector resistance. Therefore، natural insecticides/larvicides are an alternative to using chemical insecticides to control the mosquito vector.

Methods

Brusatol was isolated from the seeds of Makassar Fruit (Brucea javanica L. Merr). Culex quinquefasciatus larvae were divided into 3 groups، i.e. 6 testing groups and one negative and positive control group. In the negative control group، the larvae were treated with 100 ml aquadest and positive control was treated with temephos 1 ppm. After 24 hours، dead larvae were calculated and the percentage of death was determined. The dead larvae were then examined for morphological changes using a light microscope.

Results

The higher of the concentration level of brusatol، the higher number of the death of Cx. quinquefasciatus larvae (P<0.05). The value of brusatol Lethal Concentration 50 to larvae Cx. quinquefasciatus was 0.010 ± 0.122 and value of brusatol Lethal Concentration 90 to larvae Cx. quinquefasciatus was 0.654 ± 0.081 ppm. The higher the concentration of brusatol، the morphological damage of Cx. quinquefasciatus larvae was getting worse and widespread to cause damage to the digestive tract and cuticle.

Conclusion

Brusatol isolated from the seed of B. javanica (L) Merr have larvicidal activity to the Cx. quinquefasciatus which is potential to be natural larvicide.

We aimed to evaluate the efficacy of mineral trioxide aggregate (MTA) in the treatment of endodontic disease.

Methods

Oversell، 384 patients with endodontic disease treated in Xuzhou Stomatological Hospital، Xuzhou، China، from June 2015 to June 2017 were selected، and randomly divided into four groups with 96 cases per group. The repair effects of MTA، zinc phosphate cement (ZPC)، silver amalgam and light-curing calcium hydroxide (LCH) on the teeth and dental pulp of patients in the four groups were compared. Meanwhile، the ill symptoms of the patients were observed to confirm whether they could be alleviated. Besides، whether the repair effects were related to ages of patients، perforation diameters of diseased teeth and repair materials was discussed.

Results

The success rates of MTA group، ZPC group، LCH group and silver amalgam group were 90.6%، 68.7%، 70.8% and 52.1%، respectively. The success rate of MTA group was significantly higher than that of ZPC group، silver amalgam group and LCH group. When the success rates of four groups were compared، the differences were statistically significant (P=0.0072). The patient's age، repair material and perforation diameter were positively correlated with MTA repair effect (P=0.003، P=0.002، P=0.01). The patients' teeth in each group were repaired with different materials، and the reexamination was conducted 4 weeks later. Three patients in the silver amalgam group were found to have gingival swelling.

Conclusion

The therapeutic effect of MTA was significant in the treatment of endodontic disease، and it is worthy of clinical application.

RBC variables in male group showed high statistical level of significance between age different groups (P=0.001) for all studied parameters except MCHC (P=0.423) and RDW (P=0.174). ANOVA test and multivariate tests in female group showed that there was no significant difference for all hematological parameters between age different groups. Regarding the sex differences، male participants had significantly higher red blood count (P<0.001)، hemoglobin content (P<0.001) and hematocrit (P<0.001).

Conclusion

Hematological parameters in adolescent as inhomogeneous population are not quantified sufficiently، especially hematological indices. RBC variables، regardless of the age، differ very much between male and female examinees، in favor of the male examinees. Hematological indices were insignificantly higher in males. Regarding the age of examinees، RBC variables showed significant inter-groups differences only within male adolescents. While with girls، ages span 8 to 18 yr، we did not find significant differences for most of the hematological variables.

To investigate the effect of vascular endothelial growth factor (VEGF) on tumor angiogenesis in gallbladder carcinoma.

Methods

Fifty one patients with gallbladder carcinoma were enrolled as observation group. Thirty healthy people were included as control group. Chemically synthesized siRNA sequences targeting VEGF was transfected with VEGF-siRNA. A blank group (group B)، a negative control group (transfected with independent sequence، group C)، and an inhibition group (transfected with VEGF siRNA، group D) were established. Physiological saline was set as group A. The expression of VEGF was detected by qRT-PCR. The expression of VEGF protein was detected by Western blot. MVD was used to measure microvessel density. CCK-8، Transwell and flow cytometry were used to detect cell proliferation، invasion and apoptosis.

Results

The tumor volume of nude mice and VEGF mRNA expression in group D was significantly smaller than that in group B and C (P<0.05). The MVD density in group B and C was significantly higher than that in group D (P<0.01). The proliferation of cells was detected from the 3rd day، and the proliferation of cells in the blank and negative control groups was faster than that of the inhibition group (P<0.05). The apoptosis rate of the blank group and the negative control group was lower than that of the inhibition group (P<0.001).

Conclusion

VEGF is highly expressed in serum of patients with cholangiocarcinoma، it promotes angiogenesis، proliferation and invasion of gallbladder cancer cells، and inhibits apoptosis of tumor cells.

In order to generate data on the burden of foodborne diseases in Shandong Province، we aimed to use the case monitoring data of foodborne diseases from 2016 to 2017 to estimate.

Methods

Data were obtained from the foodborne disease surveillance reporting system with dates of onset from Jan 1، 2016، to Dec 31، 2017، in Shandong، China.

Results

The places of food exposure were categorized by settings as follows: private home، catering facility، collective canteens، retail markets، rural banquets and other. Exposed food is divided into 23 categories. Overall incidence rate and proportions by exposure categories، age، and sex-specific incidence rates were calculated and sex proportions compared. Approximately 75.00% of cases who had at least one exposure settings were in private homes. The most frequently reported exposed food was a variety of food (meaning more than two kinds of food). The two-year average incidence rate was 75.78/100،000، sex-specific incidence rate was much higher for females compared to males (78.23 vs. 74.69 cases per 100،000 population). An age-specific trend was observed in the cases reported (Chi-Square for linear trend، χ2=4.39، P=0.036<0.05).

Conclusion

A preliminary estimate of 14 million cases of foodborne diseases in Shandong province each year. Future studies should focus on cross-sectional and cohort studies to facilitate the assessment of the distribution and burden of foodborne disease of the population in Shandong. Considering strengthening the burden of foodborne diseases in foodborne disease surveillance is also a feasible way.

Opportunistic parasites have been identified as human pathogens، especially in immunodeficient patients. Microsporidian and coccidian infections cause chronic diarrhea as common clinical manifestation in HIV positive patients. In this study، the frequency of opportunistic infections، including microsporidian and coccidian infections، was evaluated in HIV/AIDS patients from Tehran and phylogenic analysis was performed for E. bieneusi isolates from these patients.

Methods

One hundred and two stool samples were collected from confirmed HIV/AIDS patients، referred to Consult Center of Behavior Diseases، West Health Center، Iran University of Medical Sciences in Tehran، Iran. The samples were transferred to Research Center of Pediatric Infectious Diseases، Institute of Immunology and Infectious Diseases، Iran University of Medical Sciences from Jan 2016 to Dec 2016. After conventional formalin-ether concentration، aniline blue staining method and acid-fast staining technique were used for detection of microsporidian spores and Cyclospora oocysts. DNA was extracted and nested PCR was performed.

Results

Two (1.96%) cases were found to be positive for intestinal microsporidia infection using aniline blue staining method and were confirmed as E. bieneusi by nested PCR. One patient was found with Cyclospora cayetanensis infection by acid-fast staining method and PCR. Giardia lamblia and Blastocystis hominis were detected as non-opportunistic parasites in 1/102 (0.98%) and 2/102 (1.96%) of the HIV positive patients، respectively.

Conclusion

With respect to the use of antiretroviral therapy (ART) in HIV positive patients، we found a low frequency of infection.

Fascioliasis is one of important zoonotic disease caused by Fasciola gigantica and F. hepatica. The final hosts of this parasite are ruminants and humans. Iran is one of the endemic areas in the world، about six million people at risk of infection. The aim of this study was to identify and determine the genetic diversity of Fasciola species in cattle after distinguish of their species.

Methods

One hundred and seventeen liver specimens collected from naturally infected cattle in 5 geographical regions in 2014-2017. Flukes stained with Hematoxylin-Carmine dye to examine for the existence of sperm within seminal vesicles. DNA was extracted from each individual، and ITS1، ND1and CO1 genes were amplified using specific primers. For discrimination of Fasciola species، ITS1 PCR-RFLP was used based on digestion pattern of RsaI enzyme. Genetic analyses and diversity and neutrality indices estimated by Dnasp5 based on NDI.

Results

Six nonspermic and 111 spermic flukes were diagnosed. All of nonspermic specimens were F. gigantica and collected from South East، South West and North West of Iran. Genetic haplotype diversity has been observed in F. gigantica based on ND1. Fst value analysis showed that minimum and maximum genetic difference between Iranian F. gigantica with Bangladesh (Fst = 0.01414) and Egypt (Fst = 0.36653) respectively.

Conclusion

It is the first report of existing of nonspermic Fasciola. High haplotype and nucleotide diversity could be due to ecological factors in life cycle، animal migration and coexisting of the final host of this parasite. Haplotype and nucleotide diversity of spermic F. gigantica in Iran and other countries in the world led to creating a variety of haplogroups.

A Decomposition Analysis of Inequality in Malnutrition among under Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010Abdollah ALMASIAN KIA,Sahar GOODARZI,Heshmatollah ASADI,Ardeshir KHOSRAVI,Aziz REZAPOUR*Pages 748-757Abstract Full Text [PDF 859KB]

Background

Nutritional status at the early stages of children’s lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach.

Methods

Data were extracted from Iran's Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting، underweight، and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover، the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality.

Results

The obtained concentration indices of stunting، underweight، and wasting were respectively -0.177، -0.092، and -0.031. Socioeconomic inequality in stunting and underweight was statistically significant، however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore، maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively.

Conclusion

The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem، they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.

Most influenza vaccines are grown in embryonated eggs and residual egg proteins can cause allergic reactions in patients with egg allergy. The aim of the present study was to determine the safety of inactivated influenza vaccine in patients with egg allergy in Kurdistan Province، Iran.

Methods

This case-control study was done on 876 patients referred to Kurdistan Asthma and Allergy Clinic، Sanandaj، Iran; 635 patients with egg allergy (cases) and 241 patients without egg allergy (controls) from 2012 to 2016. All of the patients were injected seasonal influenza vaccine. Side effects including anaphylactic shock، local reaction، vomiting، coughing، sneezing، wheezing، low blood pressure، redness and itching in the eyes، abdominal pain، dyspnea، oral/facial angioedema، swollen and itching of throat were checked by an allergist within 30 min after vaccination، and followed up to 24 h. Demographic and vaccination data were entered into the SPSS software and analyzed.

Results

Out of 876 patients، 460 (52.5%) were male. Patients' ages ranged from 6 months to 80 yr (mean 13.38 ± 15.22 SD). Overall، 63 patients with egg allergy had local reactions to vaccine. Difference of local reactions between case and control groups was statistically significant (P=0.001). No anaphylactic reactions were seen after vaccination.

Conclusion

Although the risk of anaphylactic reactions to influenza vaccine in patients with egg allergy was rare، the vaccine should be administered by an allergist with precaution. The results of present study can be a confirmation of the existing evidences to prevent acute complications to influenza vaccine.